Lucas Demands Accountability from Defense Health Agency to Keep Veterans’ & Military Service Members’ Prescription Access at Rural & Family-Owned Pharmacies

Cheyenne, OK – After hearing from constituents at recent town hall meetings and directly from rural and family-owned pharmacies who serve Oklahoma veterans, military family patients, and military patients themselves, Congressman Frank Lucas (OK-03) yesterday sent a letter to Lieutenant General Ronald Place, the Director of the Defense Health Agency (DHA), expressing his concerns regarding the recent pharmacy contract that resulted in the separation of 15,000 independent or community pharmacies from the TRICARE system.

Lucas writes in his letter, “Every military service-member and TRICARE beneficiary that serves our country deserves to have easy access to Department of Defense military health care and benefits they have dutifully earned. As you are aware, on October 24, 2022, a new pharmacy contract known as TPharm5 took effect. Led by Cigna/Express Script (ESI), one immediate effect of the new contract was the separation of 15,000 independent or community pharmacies from the TRICARE system. In addition to the 15,000 independent or community pharmacies, the severance will impact approximately 400,000 beneficiaries.

“Oklahoma is home to more than 290,000 veterans and thousands of active-duty military members and families who depend on TRICARE. I proudly represent many rural veterans who live in Oklahoma’s Third District and like many of them, I share deep concerns with recent changes announced by ESI regarding military beneficiary access to pharmacies as outlined by TPharm5. In my district alone, there are over 67 pharmacies who will no longer be a part of the ESI Pharmacy Services Administrative Organization (PSAO’s).”

As recently as 2021, over 56,000 pharmacy retailers were recognized within the TRICARE network. TRICARE beneficiaries include active-duty service members, veterans, and their families. However, as a result of ESI’s newly negotiated contract on behalf of DHA, nearly 15,000 pharmacy retailers are no longer part of the TRICARE network, as of October 24th. The exodus of pharmacy retailers leaving the network leaves roughly 400,000 beneficiaries living in suburban, rural, and underserved communities with limited access to care- including thousands in Oklahoma’s Third Congressional District.

You can read the full letter here or below:

Lieutenant General Place, 

Every military service-member and TRICARE beneficiary that serves our country deserves to have easy access to Department of Defense military health care and benefits they have dutifully earned. As you are aware, on October 24, 2022, a new pharmacy contract known as TPharm5 took effect. Led by Cigna/Express Script (ESI), one immediate effect of the new contract was the separation of 15,000 independent or community pharmacies from the TRICARE system. In addition to the 15,000 independent or community pharmacies, the severance will impact approximately 400,000 beneficiaries. 

Oklahoma is home to more than 290,000 veterans and thousands of active-duty military members and families who depend on TRICARE. I proudly represent many rural veterans who live in Oklahoma’s Third District and like many of them, I share deep concerns with recent changes announced by ESI regarding military beneficiary access to pharmacies as outlined by TPharm5. In my district alone, there are over 67 pharmacies who will no longer be a part of the ESI Pharmacy Services Administrative Organization (PSAO’s). Enclosed is a list provided by ESI, which provides further details of the list of independent or community pharmacies who are no longer considered in-network through TRICARE. Please keep in mind this list solely covers independent or community pharmacies and does not include numerous pharmacy locations from chain-retail companies such as Wal-Mart who are no longer participating in TPharm5.

I, along with thousands of rural veterans and military beneficiaries who have been impacted by the Department’s actions are alarmed there are numerous independent or community pharmacies that may have unknowingly been dropped given the short notice to affirmatively respond to ESI. Our military beneficiaries, and especially our rural veterans, depend on local and independent community pharmacies for medications that are crucial to their health and well-being. Given my strong concerns coupled with critical feedback I’ve received from my veterans and local pharmacists, I am requesting answers to my questions by Monday, November 14, 2022.

1. I am told the original date for execution of TPharm5 was December 31, 2022. Because of concerns of rolling out TPharm5, it’s my understanding the decision for implementation on October 24, 2022, was made to avoid disruptions during the holiday season. Instead of rolling out TPharm5 two months early, why wasn’t the program delayed by two months to avoid confusion and provide stakeholders more time to prepare for changes? 
2. If an independent or community pharmacy was unaware of ESI’s October 24, 2022 deadline and they are interested in joining TPharm5, what steps is DHA and ESI taking to ensure interested pharmacies are able to re-join? 
3. Is there data used in the decision-making process for TPharm5 that states military beneficiaries prefer delivery of prescriptions through mail as opposed to a brick-and-mortar pharmacy?
4. How were military beneficiaries notified their current pharmacy will no longer be a part of TPharm5? By what methods and how many times were individual military beneficiaries notified?  
5. Will you commit to DHA hosting a virtual townhall, so they can hear from military beneficiaries, as well as independent and community pharmacies who wish to provide feedback on the implementation process? 

I urgently request your response to these questions.

###